Abstract
Abstract: :
Purpose: Intravitreal injection of triamcinolone acetonide has been used to treat a variety of ocular diseases and appears to be well tolerated. We reviewed our experience using intravitreal triamcinolone injections in patients with severe uveitis to determine the effectiveness of treatment, duration of effect and complications. Methods: After local IRB approval, a list of University of Iowa patients with the CPT code for intraocular injection from January 1, 1998 to the present was created. All the patient records were reviewed to sort out those who received intravitreal Kenalog for severe noninfectious uveitis. These records were then evaluated for: diagnosis, dose and method of injection, therapeutic effect, duration of effect, complications, and need for surgery or repeat injection. Results:We identified 10 patients with severe uveitis who received intraocular Kenalog. Diagnoses included: multifocal choroiditis with panuveitis (3), sympathetic ophthalmia (3), serpiginous choroiditis (2), sarcoidosis (1), and uveitic glaucoma(1). All patients received 4mg/0.1ml of commercially available Kenalog (triamcinolone acetonide 40mg/ml) through the pars plana under topical anesthesia. Topical povidone iodine solution was used in each case to reduce the risk of infection. Patients received from one to ten injections during follow–up for a total of 27 injections. Mean followup was 14 months and ranged from 1 to 35 months. Improved vision (> 2 lines) occurred in 3 patients. 5 patients remained stable and 2 patients had worsening vision (>2 lines). All patients had reduced inflammation. No patient developed endophthalmitis. One patient required a seton for uncontrolled steroid response glaucoma. There were no other IOP complications. All three patients with sympathetic ophthalmia and one patient with multifocal choroiditis required multiple injections (3–10). Duration of effect was variable and related to severity of inflammation at time of injection and presence of a trabeculectomy or seton. Conclusions:Intravitreal triamcinolone injection is effective in decreasing inflammation and stabilizing vision in patients with severe uveitis. Multiple injections may be required.
Keywords: inflammation • corticosteroids • injection